A comparative study of the prevalence of hyperkalemia with the use of angiotensin-converting enzyme inhibitors versus angiotensin receptor blockers

Abstract

Background and objectives: Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) are increasingly used in a variety of settings including heart failure, renal failure, arterial hypertension, and diabetic nephropathy. The objective of this study was to investigate the prevalence of hyperkalemia with ACEI and ARB use, in a population of the United States veterans. Design, settings, material, and measurements: Retrospective observational cohort study of 1163 patients on ACEIs and 1168 patients on ARBs in a single Veterans Affairs Medical Center. Electronic medical records were reviewed over a 12-month period with data collected on various demographic, laboratory, comorbidity, and medication related variables. Results: Hyperkalemia (5 mEq/L) was observed in 20.4% of patients on ACEIs and 31.0% on ARBs. Severe hyperkalemia (6 mEq/L or higher), was observed in 0.8% of ACEI and 2.8% of ARB users. In univariate logistic regression analyses, diabetes mellitus; serum glucose, total carbon dioxide content, creatinine, and estimated glomerular filtration rate (GFR) were significantly associated with hyperkalemia. ARB use, when compared to ACEI, was associated with a 42% increase in odds of hyperkalemia (odds ratio [OR] = 1.42; p = 0.001) in a model including adjustment for GFR and a 56% increase in odds of hyperkalemia (OR = 1.56; p  0.001) in a model including adjustment for serum creatinine. Conclusions: Hyperkalemia, associated with the use of ACEIs and ARBs, is usually mild and severe hyperkalemia is rare. Hyperkalemia is more common with ARBs than ACEIs. ARB use, when compared to ACEI use, may significantly and independently be associated with increased odds of hyperkalemia.

Association of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Blockers With Severity of COVID-19: A Multicenter, Prospective Study

“… 19 In non-COVID-19 patients, hyperkalemia is not an uncommon adverse reaction of ACE-I/ARB therapy, occurring at rates exceeding 20%. 23 Interestingly, hyperkalemia was not associated with ACE-I/ARB use in our study. Possibly, the degradation of ACE2 by SARS-CoV-2 binding countered the potassium retaining activity of ACE-I/ARB.…”

Comparative effect of angiotensin II type I receptor blockers and calcium channel blockers on laboratory parameters in hypertensive patients with type 2 diabetes

“…The relative risk of hyperkalemia was 2-fold higher with dual therapy (ARB plus ACEI) than with monotherapy (ARB or ACEI) [ 25 ]. Use of ARBs and ACEIs is associated with a high prevalence of hyperkalemia, and the prevalence of hyperkalemia is significantly higher in ARB users than in ACEI users [ 5 ]. Supporting these previous reports of hyperkalemia, our study showed that ARB monotherapy caused electrolyte imbalance with respect to the serum level of potassium.…”

“…While ARBs and CCBs have a favorable effect on blood pressure and decrease the risk of several complications, these drugs have some adverse effects. Renin-angiotensin system inhibitors including ARBs are known to cause hyperkalemia [ 5 ] and anemia [ 6 , 7 ]. CCBs are known to cause edema [ 8 ].…”

Management of hyperkalemia during treatment with mineralocorticoid receptor blockers: findings from esaxerenone

“…In patients with diabetes, multiple studies have reported that treatment with MR blockers [ 87 , 88 ], ARBs [ 89 , 90 ], ACE inhibitors [ 90 ], or a direct renin inhibitor [ 91 ] is associated with an increase in potassium levels and a risk of severe hyperkalemia in a small number of patients. In patients with systolic heart failure, large randomized studies investigating ACE inhibitors or ARBs have demonstrated significant increases in serum potassium during treatment.…”